Treatment of Brachymetatarsia by Distraction Osteogenesis Using Monolateral External Fixator.

Objective To describe the profile of the patients and the results obtained with the use of an external fixator for metatarsal lengthening in brachymetatarsia. Methods A retrospective analysis of the medical records of patients with brachymetatarsia treated between January 2018 and April 2020 was performed. During this period, eight feet of six patients were operated on. Frequencies were estimated according to demographic and surgical aspects. Results All patients (100%; n = 6) were female, with a mean age of 28 years old, ranging from 15 to 48 years old, and were motivated to seek the orthopedic service due to aesthetic deformity. The deformity was bilateral in two patients and unilateral in four patients. The average lengthening time was 22 days ( ± 7.15, 95% confidence interval [CI]: 19.04-26.81). The lengthening speed was 0.5 mm/day, and the average total length of the lengthening was 11.46 mm ( ± 3.57; 95%CI: 9.52-13.40). Half of the patients (50%; n = 3) had local infection of the pins and were treated with antibiotics, and the others did not report any postsurgical complications. All patients denied pain or calluses after the surgical procedure and reported satisfaction with the results. Conclusion All patients were female and sought surgery for brachymetatarsia for aesthetic reasons. Osteogenic distraction at a rate of 0.5 mm/day resulted in successful lengthening of the metatarsal, with a low frequency of complications, good clinical outcomes, and high patient satisfaction.

Treatment of Brachymetatarsia by Distraction Osteogenesis Using Monolateral External Fixator / Tratamento da braquimetatarsia por distração osteogênica com fixador externo monolateral

Abstract Objective To describe the profile of the patients and the results obtained with the use of an external fixator for metatarsal lengthening in brachymetatarsia. Methods A retrospective analysis of the medical records of patients with brachymetatarsia treated between January 2018 and April 2020 was performed. During this period, eight feet of six patients were operated on. Frequencies were estimated according to demographic and surgical aspects. Results All patients (100%; n= 6) were female, with a mean age of 28 years old, ranging from 15 to 48 years old, and were motivated to seek the orthopedic service due to aesthetic deformity. The deformity was bilateral in two patients and unilateral in four patients. The average lengthening time was 22 days ( ± 7.15, 95% confidence interval [CI]: 19.04-26.81). The lengthening speed was 0.5 mm/day, and the average total length of the lengthening was 11.46 mm ( ± 3.57; 95%CI: 9.52-13.40). Half of the patients (50%; n= 3) had local infection of the pins and were treated with antibiotics, and the others did not report any postsurgical complications. All patients denied pain or calluses after the surgical procedure and reported satisfaction with the results. Conclusion All patients were female and sought surgery for brachymetatarsia for aesthetic reasons. Osteogenic distraction at a rate of 0.5 mm/day resulted in successful lengthening of the metatarsal, with a low frequency of complications, good clinical outcomes, and high patient satisfaction.

Resumo Objetivo Descrever o perfil dos pacientes e os resultados obtidos com o uso de fixador externo para alongamento de metatarso em braquimetatarsia. Métodos Foi realizada uma análise retrospectiva dos prontuários de pacientes com braquimetatarsia tratados entre janeiro de 2018 e abril de 2020. Durante este período, foram operados oito pés de seis pacientes. Foram coletadas e estimadas as frequências em relação a aspectos demográficos e cirúrgicos. Resultados Todas as pacientes (100%; n= 6) eram do sexo feminino, com média de idade de 28 anos, variando de 15 a 48 anos, e motivadas a buscar o serviço de ortopedia em função da deformidade estética. O acometimento era bilateral em duas pacientes e unilateral em quatro pacientes. O tempo médio de alongamento foi de 22 dias ( ± 7,15; intervalo de confiança [IC] 95%: 19,04-26,81). A velocidade de alongamento foi de 0,5 mm/dia e o comprimento médio total do alongamento foi de 11,46 mm ( ± 3,57; IC95%: 9,52-13,40). Metade das pacientes (50%; n= 3) teve infecção local dos pinos e foi tratada com antibióticos; as demais não relataram nenhuma complicação pós-cirúrgica. As pacientes negaram dor ou calosidade após o procedimento cirúrgico e relataram satisfação com os resultados. Conclusão Todas as pacientes eram do sexo feminino e buscaram a cirurgia para braquimetatarsia por motivos estéticos. A distração osteogênica a uma taxa de 0,5 mm/dia resultou em alongamento bem-sucedido do metatarso, com uma baixa frequência de complicações, bons resultados clínicos e alta satisfação das pacientes.

Benefits of Using Low-level Laser Therapy in the Rapid Maxillary Expansion: A Systematic Review.

AIM AND OBJECTIVE: Determine the benefits of low-level laser therapy (LLLT) as a complement to rapid maxillary expansion (RME), through a systematic review. BACKGROUND: Transversal maxillary compression is a common skeletal problem that can be treated with different devices. This RME technique consists of the separation and regeneration of the midpalatal suture. Low-level laser therapy has been suggested to be able to accelerate bone healing after trauma or bone defects. REVIEW RESULTS: Thirty-two publications were found by electronic search during July to August of 2019 on Medline (PubMed) and Google Scholar, using the terms "Low-Level Laser", "LLLT", "Rapid Maxillary Expansion", and "Osteogenesis Distraction". Only 16 were used (2 systematic reviews, 6 articles on humans, and 8 on animals). Even though all the studies had different intervention protocols, they all revealed that LLLT has the effect of accelerating bone regeneration after RME. CONCLUSION: The use of LLLT as a complement to RME has shown promising results with cellular biostimulation, promoting angiogenesis and bone regeneration of the midpalatal suture. CLINICAL SIGNIFICANCE: This study provides scientific evidence of the benefits of using LLLT as a complement to RME during orthopedic and orthodontic treatments, accelerating bone regeneration and reducing the time of consolidation of the maxillary. HOW TO CITE THIS ARTICLE: Lai P-S, Fierro C, Bravo L, et al. Benefits of Using Low-level Laser Therapy in the Rapid Maxillary Expansion: A Systematic Review. Int J Clin Pediatr Dent 2021;14(S-1):S101-S106.

A comparison of tooth-borne and bone-anchored expansion devices in SARME.

PURPOSE: Major adult maxillary transverse discrepancies are usually treated with surgically assisted rapid maxillary expansion (SARME), utilizing a combination of surgical and orthodontic techniques. Unfortunately, a consensus has not been reached on topics ranging from the best surgical technique that should be performed to the ideal expander type that should be installed. The present study sought to evaluate the efficiency and stability of the maxillary expansion achieved with two types of expanders following the same SARME procedure without pterygomaxillary disjunction (PMD). METHODS: Twenty-four patients with a maxillary transverse deficiency were enrolled in the study. All patients underwent the same SARME, and 12 received a bone-anchored (KLS Martin®) and 12 were installed with a tooth-borne (Hyrax®) expander. Dental impressions were collected both preoperatively and 1 year postoperatively. These casts were scanned and the distances between specific interdental and intergingival points were measured and analyzed. Statistical analyses were performed to assess the effects expander type had on the efficiency of the maxillary expansion and long-term stability. RESULTS: Expansion in the anterior maxillary and premolar regions was found to be similar in both groups. In contrast, the tooth-borne device resulted in a significantly greater expansion in the molar region. CONCLUSION: The SARME technique without PMD is highly effective at treating adults with maxillary transverse deficiencies, and the type of expander selected depends on the location of the larger maxillary constriction region of each patient.

Distração osteogênica da sínfise mandibular como opção de tratamento da síndrome da apneia e hipopneia do sono em paciente com sequência de Pierre ­ Robin / Osteogenic distraction of the mandibular symphysis as an option for the treatment of sleep apnea and hypopnea syndrome in a patient with Pierre - Robin sequence

Introdução: Glossoptose e retrognatia, associadas a distúrbios respiratórios, compõem a Sequência de Robin (SR), que pode estar associada a uma variedade de síndromes genéticas. Sua incidência varia entre 1/5.000 e 1/50.000 nascidos vivos, cursando com níveis variáveis de comprometimento respiratório. A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) se destaca entre tais distúrbios, conferindo risco de morte neonatal e tempo prolongado de internação. Disfagia é sintoma frequente em pacientes com SR sindrômica, com risco de aspiração. Dentre as alternativas para tratamento do distúrbio respiratório, distração óssea mandibular (DOSM) é uma rápida e definitiva opção, podendo prevenir sequelas, como danos cerebrais por hipóxia, além de corrigir a micrognatia permanentemente. Objetivo: relatar padrão respiratório e da deglutição em paciente com SR após avanço mandibular por distração osteogênica Resultado e discussão: relatamos um caso de paciente com SPR associada à SAHOS grave: índice de distúrbio respiratório (IDR) =18/h, atraso do desenvolvimento neuro-psico-motor, respiração oral e disfagia de grau severo com dieta exclusiva por gastrostomia. Conclusão: após realização de DOSM, houve melhora da SAHOS e a dieta passou a ser ministrada via oral.

Introduction: glossoptosis and retrognatia, associated with respiratory disorders, compose the Robin Sequence (RS), which may be associated with a variety of genetic syndromes. Its incidence ranges from 1/5,000 to 1/50,000 live births with varying levels of respiratory compromise. The Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) stands out among such disorders, conferring neonatal death risk and prolonged hospitalization time. Dysphagia is a frequent symptom in patients with syndromic SR, with risk of aspiration. Among the alternatives for the treatment of respiratory disorder, mandibular bone distraction (MBD) is a rapid and definitive option, which can prevent sequelae, such as brain damage through hypoxia, and correct micrognathia permanently. Objective: to report improvement of the respiratory and swallowing pattern in a case of PRS by osteogenic mandible distraction. Result and discussion: we report a case of a patient with SPR associated with severe OSAHS: respiratory distress index (IDR) = 18 / h, neuropsychological-motor development delay, oral breathing, and severe-grade dysphagia with an exclusive gastrostomy diet. Conclusion: after DOSM, there was improvement in OSAHS and the diet was administered orally.

Systemic melatonin application increases bone formation in mandibular distraction osteogenesis

Abstract This study aimed to investigate the effects of different doses of systemic melatonin application on new bone formation during mandibular distraction osteogenesis (DO) in rats. Mandibular DO was performed on 30 adult female Sprague-Dawley rats, which were randomly divided into three groups: control group (CNT), melatonin dose 1 (MLT-D1), and melatonin dose 2 (MLT-D2). A five-day latent waiting period and a ten-day distraction phase followed the surgery. After the surgery, rats from the MLT-D1 and MLT-D2 groups received 25 and 50 mg/kg melatonin, respectively, at 7, 14, 21, 28, and 35 days. The animals were euthanised 28 days after distraction, i.e. at 43 days after surgery. Histological and histomorphometric analyses revealed that the distracted bone area was completely filled with new bone formation in all three groups. The MLT-D2 group exhibited the most new bone formation, followed by MLT-D1 and CNT. The melatonin groups had more osteoclasts than the CNT (p < 0.05). The number of osteoblasts was higher in the melatonin groups than in the CNT group, and the MLT-D2 had more osteoclasts than the MLT-D1 group (p < 0.05). Finally, the osteopontin (OPN) and vascular endothelial growth factor (VEGF) levels were higher in the melatonin groups than in the CNT group, and the MLT-D2 had higher OPN and VEGF levels than the MLT-D1 (p < 0.05). This study suggests that systemic melatonin application could increase new bone formation in DO.

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital.

OBJECTIVE: To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. METHODS: Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05). RESULTS: 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). CONCLUSION: Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

OBJETIVO: Avaliar as características clínicas dos pacientes submetidos à distração osteogênica por falha óssea em hospital universitário. MÉTODOS: Estudo transversal, retrospectivo, com amostra de conveniência, de 2000 a 2012, das características clínicas de pacientes tratados e submetidos à distração osteogênica (transporte ósseo) com uso de fixador externo circular tipo Ilizarov. Foram usados os testes de qui-quadrado, exato de Fisher e U de Mann­Whitney, com nível de significância de 5% (p < 0,05). RESULTADOS: Foram 33 casos, 28 homens (84,8%). A idade mais frequente foi entre 21 e 40 anos. A maioria dos pacientes (57,6%) era da região metropolitana. O segmento mais afetado foi a perna (75,8%) e o lado foi o esquerdo (66,7%). A causa mais frequente foi a pseudoartrose infectada (75,8%). O tipo de transporte ósseo feito foi principalmente o bifocal (75,8% dos casos). A média de procedimentos prévios em outra instituição foi de 2,62 cirurgias (desvio padrão de 1,93) e a dos feitos após o início do tratamento foi de 1,89 cirurgia (desvio padrão de 1,29). O tempo de uso de fixador externo foi de 1,94 ano (desvio padrão de 1,34), com mínimo de um ano e máximo de seis. As quatro complicações mais encontradas foram infecção de base de pinos (57,6% dos casos), equino (30,3%), infecção profunda (24,2%) e encurtamento (21,2%). CONCLUSÃO: A necessidade de distração osteogênica por falhas ósseas foi mais frequente em adultos jovens, homens, na perna, com transporte bifocal, após múltiplas cirurgias prévias, com média de aproximadamente dois anos de tratamento e com várias complicações (as infecções foram as principais).

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital / Avaliação clínica de pacientes submetidos à distração osteogênica no membro inferior em hospital universitário

ABSTRACT OBJECTIVE: To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. METHODS: Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05). RESULTS: 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). CONCLUSION: Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

RESUMO OBJETIVO: Avaliar as características clínicas dos pacientes submetidos à distração osteogênica por falha óssea em hospital universitário. MÉTODOS: Estudo transversal, retrospectivo, com amostra de conveniência, de 2000 a 2012, das características clínicas de pacientes tratados e submetidos à distração osteogênica (transporte ósseo) com uso de fixador externo circular tipo Ilizarov. Foram usados os testes de qui-quadrado, exato de Fisher e U de Mann-Whitney, com nível de significância de 5% (p < 0,05). RESULTADOS: Foram 33 casos, 28 homens (84,8%). A idade mais frequente foi entre 21 e 40 anos. A maioria dos pacientes (57,6%) era da região metropolitana. O segmento mais afetado foi a perna (75,8%) e o lado foi o esquerdo (66,7%). A causa mais frequente foi a pseudoartrose infectada (75,8%). O tipo de transporte ósseo feito foi principalmente o bifocal (75,8% dos casos). A média de procedimentos prévios em outra instituição foi de 2,62 cirurgias (desvio padrão de 1,93) e a dos feitos após o início do tratamento foi de 1,89 cirurgia (desvio padrão de 1,29). O tempo de uso de fixador externo foi de 1,94 ano (desvio padrão de 1,34), com mínimo de um ano e máximo de seis. As quatro complicações mais encontradas foram infecção de base de pinos (57,6% dos casos), equino (30,3%), infecção profunda (24,2%) e encurtamento (21,2%). CONCLUSÃO: A necessidade de distração osteogênica por falhas ósseas foi mais frequente em adultos jovens, homens, na perna, com transporte bifocal, após múltiplas cirurgias prévias, com média de aproximadamente dois anos de tratamento e com várias complicações (as infecções foram as principais).

Vertical bone augmentation of posterior mandibular region: a description of two surgical techniques / Aumento ósseo em altura da região mandibular posterior: descrição de duas técnicas cirúrgicas

ABSTRACT Correction of severe vertical bone deficiency in the posterior region of mandibular alveolar ridge requires surgical management if implants are scheduled and cannot have primary stability. The aim of the present study is to report two cases; one treated with alveolar osteogenesis distraction and the other with segmental osteotomy with autologous graft interposition, by describing the surgical steps as well as show the results and experiences acquired with these techniques. We opted for these methods to reconstruct the posterior mandibular region after remarkable vertical bone loss based mainly by the height and thickness of the remaining bone. Alveolar osteogenic distraction is highly advisable when vertical deficiency is severe, and if these cases are treated with the segmental osteotomy and autologous graft interposition, complications as graft failure, necrosis and resorption are more prone to occur due to insufficient vascularization. After bone maturation and bone neoformation secondary to alveolar osteogenic osteogenic distraction and segmental osteotomy with autologous graft interposition, respectively, the two presented case reports were able to securely receive dental implants. In cases of vertical bone loss of the posterior mandibular region, both surgeries currently represent the best choice for bone gain prior dental implants placement for oral rehabilitation, without technical challenges, although biological evidence to assure the superiority of one technique over the other must be further investigated.

RESUMO A correção de deficiência óssea severa em altura na região posterior do rebordo alveolar da mandíbula requer tratamento cirúrgico caso a inserção de implantes dentários seja necessária e não se pode ter uma estabilidade primária. O objetivo do presente estudo é relatar dois casos; um tratado com distração osteogênica alveolar e o outro com osteotomia segmentar associada à interposição de um enxerto autógeno, descrevendo a sequência cirúrgica, bem como mostrar os resultados e as experiências adquiridas com essas técnicas. Optamos por esses métodos para reconstruir a região mandibular posterior baseados principalmente na altura e espessura óssea remanescentes. A distração osteogênica alveolar é altamente recomendável quando essa deficiência é avançada e, se esses casos são tratados com a osteotomia segmentar e interposição de enxerto autógeno, complicações como falha do enxerto, necrose e reabsorção são mais prováveis de ocorrer devido à vascularização sua insuficiente. Após os períodos de reparação e neoformação óssea secundária à distração osteogênica alveolar e à osteotomia segmentar com interposição de enxerto autógeno, respectivamente, os dois casos relatados estavam aptos a receberem seguramente os implantes dentários. Nos casos de perda óssea em altura na região mandibular posterior, ambas as cirurgias representam, atualmente, a melhor escolha para o ganho de estrutura óssea antes da colocação dos implantes dentários e reabilitação oral, sem muita complexidade quanto à técnica cirúrgica, embora ainda sejam necessário estudos posteriores para assegurar a superioridade de uma técnica em relação a outra.

Effect of autologous stem cells on regenerated bone during distraction osteogenesis by Ilizarov technique in the radius of dogs: histomorphometric analysis

PURPOSE:To investigate by histomorphometry the distraction osteogenesis by Ilizarov technique in dog radius with the use of autologous stem cells in regenerated bone. METHODS:Ten dogs (20 radiuses) underwent the osteotomy of 20% of extension of their radiuses, and osteogenic distraction using the Ilizarov technique after this procedure at rate of 1mm per day divided into 0.5mm every 12 hours. The elongation was performed until the regeneration reached 20% of the total length of the radius. The stem cells were isolated, concentrated and injected in the regenerated bone, when it reached 10% of the length of the entire radius. The regenerated bone was evaluated using histomorphometric analysis when the elongation was 20% the size of radius. RESULTS: The bone formation was evidenced by histomorphometric indices were significantly greater in the study group. In the histology evaluation the type of healing was mixed in 80% (intra membrane and endocondral) in both groups; the osteoblastic activity from moderate to intense was greater in the study group; and the space occupied by the newly-formed bone tissue was more evident in the study group. CONCLUSIONS:The histomorphometric indices in this study expressing the microarchitecture, trabecular thickness, trabecular spacing, number of trabecula and quantity of bone that was significant in the group study. These data suggest that the use of undifferentiated stem cells autologous bone marrow in the regenerate bone induces osteogenesis and bone quality.(AU)

Effect of autologous stem cells on regenerated bone during distraction osteogenesis by Ilizarov technique in the radius of dogs: histomorphometric analysis

PURPOSE:To investigate by histomorphometry the distraction osteogenesis by Ilizarov technique in dog radius with the use of autologous stem cells in regenerated bone. METHODS:Ten dogs (20 radiuses) underwent the osteotomy of 20% of extension of their radiuses, and osteogenic distraction using the Ilizarov technique after this procedure at rate of 1mm per day divided into 0.5mm every 12 hours. The elongation was performed until the regeneration reached 20% of the total length of the radius. The stem cells were isolated, concentrated and injected in the regenerated bone, when it reached 10% of the length of the entire radius. The regenerated bone was evaluated using histomorphometric analysis when the elongation was 20% the size of radius. RESULTS: The bone formation was evidenced by histomorphometric indices were significantly greater in the study group. In the histology evaluation the type of healing was mixed in 80% (intra membrane and endocondral) in both groups; the osteoblastic activity from moderate to intense was greater in the study group; and the space occupied by the newly-formed bone tissue was more evident in the study group. CONCLUSIONS:The histomorphometric indices in this study expressing the microarchitecture, trabecular thickness, trabecular spacing, number of trabecula and quantity of bone that was significant in the group study. These data suggest that the use of undifferentiated stem cells autologous bone marrow in the regenerate bone induces osteogenesis and bone quality.

Nautilus: craniotomia dinâmica - nova técnica cirúrgica e resultados preliminares / Nautilus-shaped dynamic craniotomy: a new surgical technique and preliminary results

INTRODUÇÃO: Considerando-se que as craniossinostoses são afecções basicamente suturais, o fato de o cérebro estar aprisionado em um compartimento fechado, que não possui a complacência necessária para acompanhar seu crescimento, se constitui no desafio principal de seu tratamento. O objetivo do tratamento é restabelecer a complacência da sutura estenótica e corrigir a deformidade craniana compensatória. Este trabalho propõe a associação de osteotomia helicoide à distração osteogênica proporcionada pelo uso das molas distratoras para remodelar defeitos craniofaciais causados por craniossinostoses. MÉTODO: Entre julho de 2010 e julho de 2012, foram tratados 10 pacientes portadores de craniossinostoses, sendo 5 oxicefalias, 3 escafocefalias, 1 turricefalia e 1 trigonocefalia. O tratamento consistiu na aplicação de molas de Lauritzen, para corrigir a deformidade primária da craniossinostose, com a associação de craniotomia helicoide em forma de Nautilus nos sítios de deformação secundária do crânio, sem descolamento dural. RESULTADOS: Foi observada resolução da deformidade craniana e remissão dos sinais clínicos de hipertensão intracraniana. Nenhum paciente apresentou complicações, como fístula liquórica, infecção local, seroma ou hematoma. CONCLUSÕES: A associação da osteotomia helicoide com a distração ou contração promovida pelas molas permitiu remodelar ativamente o crânio, facilitando a acomodação do conteúdo cerebral no continente craniano.

INTRODUCTION: Considering that craniosynostosis is a suture-related condition, the main challenge for its treatment is the fact that the brain is located in a closed compartment that does not have the required adaptability to accommodate its growth. The goal of treatment is to restore stenotic suture adaptability and correct the compensatory cranial deformity. This paper proposes the combined use of spiral osteotomy with distraction osteogenesis by the use of distracting springs to remodel craniofacial defects caused by craniosynostosis. METHODS: Between July 2010 and July 2012, 10 patients with craniosynostosis were treated: 5 with oxycephaly, 3 with scaphocephaly, 1 with turricephaly, and 1 with trigonocephaly. The treatment consisted of the application of Lauritzen springs to correct the primary craniosynostosis defect in combination with a nautilus-shaped spiral craniotomy at the secondary deformation sites without dural detachment. RESULTS: Resolution of cranial deformity and remission of the clinical signs of intracranial hypertension were observed. None of the patients had complications such as cerebrospinal fluid fistula, local infection, seroma, or hematoma. CONCLUSIONS: The combined use of spiral osteotomy with spring-mediated distraction or contraction enables active reshaping of the skull and facilitates accommodation of the brain by the cranial cavity.

Histological and physical analysis of bone neoformation by osteogenesis distraction: A preliminary report.

INTRODUCTION: Osteogenesis distraction (OD) is a mainstream technique in maxillofacial surgical reconstruction with varied applications. OD technique employs a distractor with the aim to get new bone in the site of interest. Osseous maturation time is necessary before the device can be removed and few patients' complaint of related discomfort, especially when these devices are external, and induces superficial infections, paresthesia, hypertrophic scars and social relationship difficulties. The use of Low Level Laser Therapy (LLLT) has been proved beneficial to soft tissue and osseous repairs. MATERIALS AND METHOD: 12 rabbits were randomly divided in to two groups. In all animals, distractor was placed and one group was exposed to LLLT while the other group served as control. After consolidation, animals were sacrificed, the new bone formed were subjected to investigations including histomorphometric, physical analysis and tomographical analysis. Statistical analyses were performed using SPSS software. RESULT: Newly formed bone was significantly different between the groups. The physical properties of the neobone were comparatively better when the animals were exposed to LLLT with varying statistical significance. CONCLUSION: The results obtained with smaller sample size in this study need to be interpreted with care. The results of this preliminary pilot study encourage the use of LLLT during healing period. However the histological, tomographical and physical findings need to be ascertained using a larger sample size to study the bio-stimulatory effects with laser therapy from basics to clinical relevance on wound and bone healing.

Distração osteogênica em implantodontia: relato de caso / Distraction osteogenesis in implantology: case report

As deficiências ósseas horizontais e verticais dos maxilares requerem, na maioria das vezes, cirurgias prévias para o aumento ósseo quando se pensa em reabilitação com implantes. Para pacientes que procuram tratamento com o intuito de melhorar ou recuperar a função mastigatória, a fonética e a estética bucal, existem diversos tipos de tratamentos para recuperar a altura óssea perdida dos rebordos alveolares, visando uma futura reabilitação com implantes osseointegrados. A distração osteogênica é uma técnica empregada para o ganho de tecido ósseo e de tecidos moles em cirurgia ortopédica e vem sendo aplicada desde 1996 por cirurgiões bucomaxilofaciais para reconstrução de rebordos alveolares mandibulares e maxilares, com a finalidade de permitir a instalação de implantes osseointegrados bem posicionados e com maior previsibilidade de sucesso, quando submetidos a cargas funcionais. A técnica consiste no alongamento dos tecidos moles e duros, permitindo bons e previsíveis resultados, além de apresentar menor morbidade e dispensar a necessidade de um segundo local cirúrgico quando comparada à técnica de enxertos. O objetivo deste trabalho é demonstrar a aplicabilidade desta técnica através do relato de um caso clínico de uma paciente com atrofia do rebordo alveolar que foi submetida a procedimento de distração osteogênica, com posterior instalação de implantes osseointegráveis.

The horizontal and vertical bone defects of the jaws in most cases require surgery for the bone increase when considering implants rehabilitation. For patients seeking treatment in order to improve or restore the chewing function, phonetics and oral aesthetics, there are several types of treatments to restore lost bone height of alveolar ridges, seeking a future reconstruction with osteointegration implant. Distraction osteogenesis is a technique for gaining bone and soft tissue in orthopedic surgery and has been applied since 1996 by maxillofacial surgeons for reconstruction of mandibular and maxillary alveolar ridges, in order to allow the installation of dental implants well positioned and greater predictability of success, when subjected to functional loads. The technique consists of stretching soft and hard tissue allowing good and predictable results, and have lower morbidity and obviate the need for a second surgical site when compared to the graft technique. The objective is to demonstrate the applicability of this technique through a case report of a patient with atrophy of the alveolar ridge that was submitted to Distraction Osteogenesis procedure, with subsequent placement of osseointegrated implants.

Spring-mediated skull expansion: overall effects in sutural and parasutural areas. An experimental study in rabbits / Expansão craniana com molas: efeitos globais nas áreas suturais e parassuturais. Estudo experimental em coelhos

Purpose: The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. Methods: Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. RESULTS: In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. Conclusion: The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.

Objetivo: O uso de molas na expansão craniana tem provado ser efetivo no tratamento da craniossinostoses. A expansão com molas tem sido estudada nas regiões sagital e parassagital, especialmente nas escafocefalias. Um modelo com coelho foi usado no presente estudo para analizar os efeitos das molas sobre a calota craniana e suturas. Métodos: Treze coelhos Nova Zelândia, com quarto semanas de vida, foram divididos em quatro grupos: no grupo I, somente marcadores de amálgama foram implantados como controle; no grupo II, marcadores de amálgama foram implantados e foi retirada a sutura sagital; no grupo III, marcadores de amálgama foram implantados, foi retirada a sutura sagital e foi colocada uma mola expansora na região interparietal e no grupo IV, marcadores de amálgamas foram implantados, uma craniectomia linear parassagital foi realizada e foi colocada uma mola expansora. Os animais foram sacrificados com 2, 4, 8 e 12 semanas. Foi realizado controle radiológico e histológico nas áreas de implantação das molas. RESULTADOS: Nos grupos que utilizaram molas a distração das margens ósseas de craniectomia foi maior do que nos grupos que não utilizaram molas. Neoformação óssea foi observada em todos os grupos, tendo sido mais rápida no grupo II. O crescimento ósseo teve início a partir das margens e da profundidade. A regeneração óssea apresentou padrões histológicos similares nos grupos com o uso de molas na região sagital e parassagital. Conclusões: O modelo experimental com coelho provou ser adequado para a análise proposta pelo estudo. O uso das molas nos grupos com osteotomia sagital e parassagital promoveu uma distração similar dos marcadores de amálgamas e ambos os grupos tiveram padrão histológico de ossificação similar.

Spring-mediated skull expansion: overall effects in sutural and parasutural areas. An experimental study in rabbits / Expansão craniana com molas: efeitos globais nas áreas suturais e parassuturais. Estudo experimental em coelhos

Purpose: The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. Methods: Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. RESULTS: In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. Conclusion: The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.(AU)

Objetivo: O uso de molas na expansão craniana tem provado ser efetivo no tratamento da craniossinostoses. A expansão com molas tem sido estudada nas regiões sagital e parassagital, especialmente nas escafocefalias. Um modelo com coelho foi usado no presente estudo para analizar os efeitos das molas sobre a calota craniana e suturas. Métodos: Treze coelhos Nova Zelândia, com quarto semanas de vida, foram divididos em quatro grupos: no grupo I, somente marcadores de amálgama foram implantados como controle; no grupo II, marcadores de amálgama foram implantados e foi retirada a sutura sagital; no grupo III, marcadores de amálgama foram implantados, foi retirada a sutura sagital e foi colocada uma mola expansora na região interparietal e no grupo IV, marcadores de amálgamas foram implantados, uma craniectomia linear parassagital foi realizada e foi colocada uma mola expansora. Os animais foram sacrificados com 2, 4, 8 e 12 semanas. Foi realizado controle radiológico e histológico nas áreas de implantação das molas. RESULTADOS: Nos grupos que utilizaram molas a distração das margens ósseas de craniectomia foi maior do que nos grupos que não utilizaram molas. Neoformação óssea foi observada em todos os grupos, tendo sido mais rápida no grupo II. O crescimento ósseo teve início a partir das margens e da profundidade. A regeneração óssea apresentou padrões histológicos similares nos grupos com o uso de molas na região sagital e parassagital. Conclusões: O modelo experimental com coelho provou ser adequado para a análise proposta pelo estudo. O uso das molas nos grupos com osteotomia sagital e parassagital promoveu uma distração similar dos marcadores de amálgamas e ambos os grupos tiveram padrão histológico de ossificação similar.(AU)

Distração osteogênica mandibular em paciente tráqueo-dependente / Mandibular osteogenic distraction in a tracheo-dependent patient

Objetivo: Descrever o caso clínico e o acompanhamento pós-operatório de uma paciente de 18 anos de idade que apresentava um quadro de micrognatia severa, causada por anquilose de ATM devido a trauma durante o parto. Relato do caso: A paciente foi primeiramente tratada da anquilose de ATM por meio de liberação das ATMs e rotação de retalho músculo/fáscia temporal. Em seguida, foi realizada a instalação de um distrator osteogênico em cada lado da mandíbula e realizadas osteotomias. O distrator foi ativado a partir do 6º dia de pós-operatório a uma média de 0.5 mm ao dia, chegando até o avanço de 25mm. A paciente obteve um perfil facial mais aceitável, e as vias aéreas posteriores se expandiram, permitindo a remoção da traqueostomia. Considerações finais: A distração osteogênica mandibular é uma boa opção para pacientes com micrognatia que necessitem de grandes avanços mandibulares, permitindo, além de uma melhor harmonia facial, um aumento do espaço aéreo superior.

Objective: To describe the clinical case and postoperative follow-up of an 18-year-old patient with a picture of severe micrognatia caused by anchylosis of the temporomandibular joint (TMJ) due to trauma during childbirth. Method: The patient was initially treated for the anchylosis by means of the release of the TMJs and rotation of the temporal musculo-fascial flap, following which an osteogenic distractor was placed on either side of the mandible and osteotomies performed. The distractor was activated from the 6th postoperative day at an average of 0.5 mm per day up to a distance of 25 mm. The patient achieved a more acceptable facial profile and the airways expanded, allowing the removal of the tracheostomy. Final considerations: Mandibular osteogenic distraction is a good option for patients with micrognatia who require major mandibular remodelling, thus permitting, in addition to a better harmony of the face, an increase in the upper air space.

Estudo do avanço maxilar e das complicações em pacientes fissurados e não-fissurados submetidos a cirurgia ortognática / Study of the maxillary advancement and complications in cleft and non-cleftpatients underwent to orthognathic surgery

Introdução: Os pacientes portadores de fissura lábio-palatina podem desenvolverhipomaxilismo devido a cicatrizes presentes no lábio e no palato durante o processo de reabilitação até a fase da adolescência. Objetivos: Avaliar e comparar o índice de avançohorizontal da maxila e das complicações em cirurgias ortognáticas, às quais foram submetidos os pacientes portadores de fissura lábio-palatina e os pacientes com diagnóstico dehipomaxilismo sem cicatrizes no lábio e no palato. Método: Foram revisados 46 prontuários consecutivos de pacientes submetidos a cirurgia entre 2006 e 2007, sendo obtidos os índicesde complicações e avanço da maxila. A análise cefalométrica à Ricketts das telerradiografias foi realizada no pré-operatório e pós-operatório de três meses, nos pacientes fissurados epacientes não-fissurados. Resultados: Os pacientes fissurados tiveram avanço horizontal médio de 4,1 mm e índice complicação de 4,7%. Os pacientes não-fissurados apresentaram avanço horizontal médio de 4,0 mm e índice de complicações de 44%. Conclusão: O avanço horizontal maxilar médio foi semelhante, mas os pacientes não-fissurados tiveram maior índicede complicações no pós-operatório. Concluiu-se, também, que este método de cefalometria é eficaz para avaliação do avanço maxilar horizontal e vertical.

Introduction: Cleft lip and palate patients can develop undergrowth of the maxilla due to scars in the process of rehabilitation until adolescence. Objective: Evaluate and compare thehorizontal advancement index of the maxilla and the complications index in the cleft and noncleft that underwent orthognathic surgery. Method: Forty six charts of pacientes underwent to surgery between 2006 and 2007 were reviewed and the indexes were obtained. The of patients horizontal advancement mean was obtained from the Ricketts cephalometricmeasurements of the pre-operative and three months post-operative cephalograms. Results: Cleft patients had a mean horizontal advancement of 4.1 mm and a complication index of 4.7%. The non-cleft patients had a mean horizontal advancement of 4.0 mm and a complication index of 44%. Conclusion: The mean horizontal advancement of the maxilla was similar but the noncleftpatients had higher index of complications. The cephalometric method used is effective in the evaluation of both the horizontal and vertical advancement of the maxilla.

Deformidade angular do rádio e da ulna tratada pela distração osteogênica percutânea dinâmica - Relato de caso

The clinical exam of a male mongrel dog, 4-month-old, and 5.7kg of live weight, showed that the dog supported with the elbows and it was observed accentuated bilateral rotacional deformity of the radius and ulna. Radiographs of the radius and ulna revealed proximal fracture of the radius. After clinical and radiographic evaluation it was indicated the corrective osteotomy and distraction osteogenesis of the left foremember. The surgical procedure consisted in osteotomy in the diaphysis of the radius and ulna, and the utilization of external fixators composed by four Kirschners pins and two metallic thread bars, configuring a fixator type II, bilateral uniplanar dynamic. Before the fixation of the pins with acrylic, the fractured bony fragments were separated in approximately 0.5cm. Starting 10 days post surgery, the radial osteotomy site was distracted at a rate of 1.0mm every day for 30 days. The consolidation of the osteotomy site was observed radiographically 67 days after the intervention, when the fixator was removed. Similar procedure was accomplished in the right foremember at the age of 16 months. At this moment, it was necessary to remove a coins bony of approximately 1.0cm for correction of the limb angulation. At present, the dog shows normal function and support of the left foremember and light valgus deformity of the right foremember due to the broken implants.

O exame de um cão de quatro meses de idade, macho, sem raça definida, com peso de 5,7kg mostrou que ele se apoiava com os cotovelos e apresentava desvio acentuado bilateral do rádio e da ulna. Ao exame radiográfico, observou-se fratura proximal bilateral do rádio. Após avaliações clínica e radiológica foi indicada a osteotomia corretiva e distração osteogênica do membro anterior esquerdo. O procedimento cirúrgico constou de osteotomia na diáfise proximal do rádio e ulna e emprego de fixadores externos compostos por quatro pinos de Kirschner e duas barras metálicas rosqueadas, configurando um fixador tipo II, bilateral uniplanar dinâmico. Antes da fixação dos pinos com acrílico, os fragmentos ósseos fraturados foram separados em aproximadamente 0,5cm. Após 10 dias, iniciou-se a distração de 1,0mm/dia durante 30 dias. A consolidação da fratura foi observada radiograficamente aos 67 dias após a intervenção, quando o aparelho foi removido. Procedimento semelhante foi realizado no membro anterior direito, quando o animal se encontrava com 16 meses de idade. Foi necessária a retirada de uma cunha óssea de aproximadamente 1,0cm para a correção angular. Atualmente, o cão mostra apoio normal do membro anterior esquerdo e discreto desvio valgus do direito devido à quebra do implante.